End-of-life Care in Long Term Care Settings in Hong Kong: Development and Evaluation

Abstract

Long term care setting has become a common site of death around the world. In Hong Kong, most of the long term care residents who are terminally ill, spend their last days in hospitals. With the aging population and growing respect for individual choices, it is anticipated that more residents will choose long term care settings as their place of end-of-life care and even place of death. The TWGHs Jockey Club Rehabilitation Complex, consists of long term care settings for older adults, started to develop the end of care in late 2006. A three-stage model is adopted. In the first stage, ten focus groups were carried out to examine the existing structure, resources, and room for development. In the second phase, the NEST assessment tool for screening the needs of the older adults was tested, and consequently a process for care was proposed. In the final stage, a multi-source and longitudinal evaluation was done with the users, family members, staff and visiting doctors. Four measures over a year were collected. Positive changes are found in quality of life. As observed by the visiting doctors, long term care residents were found to have significant changes in emotions (t = -2.40, p<.05) and overall health (t = -4.19, p< .01).